Role Description Under limited supervision the Coder Outpatient reviews medical records and performs coding on all diagnoses, procedures, APC and charge codes. The Coder Outpatient uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient’s treatment. The Coder Outpatient will be charged with maintaining the confidentiality of patient records and procedures. - Responsible for abstracting, coding, sequencing and interpreting the clinical information from inpatient, outpatient, emergency department, pro fee and clinical medical records. - Responsible for the assignment of correct principal diagnoses, secondary diagnoses and principal procedure and secondary procedure codes with attention to accurate sequencing. - Utilizes technical coding principals and DRG/APC reimbursement expertise to assign appropriate codes. - Abstracts and codes pertinent medical data into multiple software programs and/or encoders. - Follows official coding guidelines to review and analyze health records. - Maintains compliance with both external regulatory and accreditation requirements, and with State and Federal regulations. - Extracts pertinent data from the patient’s health record, and determines appropriate coding for reports and billing documents. - Identifies codes for reporting medical services, procedures performed by physicians. Enters codes into various computer systems dependent upon the various clients. - Track and document productivity in specified systems, maintain productivity levels as defined by the client. - Maintain 95% quality rating. - Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance. Qualifications - Ability to prioritize and multi-task in a fast-paced, changing environment. - Demonstrate ability to work in all work types and specialties. - Demonstrate ability to self-motivate, set goals, and meet deadlines. - Demonstrate leadership, mentoring, and interpersonal skills. - Demonstrate excellent presentation, verbal and written communication skills. - Ability to develop and maintain relationships with key business partners by building personal credibility and trust. - Maintain courteous and professional working relationships with employees at all levels of the organization. - Demonstrate excellent analytical, critical thinking and problem solving skills. - Skill in operating a personal computer and utilizing a variety of software applications. - Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes. - Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation. Requirements - No supervisory responsibility. - This job operates in a remote home office environment. - This role routinely uses standard office equipment such as computers and phones. Physical Demands - While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear. - The employee must occasionally lift or move up to 25 pounds. - Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. Position Type/Expected Hours of Work - This is a full-time position. - Days and hours of work are generally Monday through Friday, 8:00 a.m. to 5 p.m. - This position occasionally requires long hours and weekend work. Benefits - Comprehensive benefits package that may include health, dental, and vision coverage. - Voluntary insurance options. - 401(k) plan with employer match. - Professional development opportunities. - Paid time off and holiday pay. - Opportunity to participate in bonus programs, commissions, or other variable incentive plans.

Role Description The Coder III Specialist- Professional Specialty Services- Procedural reviews electronic medical record documentation, and applies ICD and CPT codes, per Official Coding Guidelines, with a specific focus on office visit and/or minor surgical procedures. This position abstracts key data elements necessary for billing and data analysis. - Reviews and analyzes the content of the medical record to determine appropriate assignment of ICD diagnosis codes, CPT procedure codes, modifiers, hierarchical condition categories, complications, and comorbidities. - Accurately reviews and codes patient records in professional office visits and/or minor surgical procedures. - Evaluates appropriateness of diagnosis and procedure codes and modifiers in response to Outpatient Code Editor and National Correct Coding Initiative edits. - Reviews clinical documentation to validate accurate representation of the patient's clinical picture, treatment, and diagnoses. - Identifies missing, non-specific, or inconsistent documentation and takes steps to obtain it. - Identifies and enters data elements for abstracting. - Meets defined coding accuracy standards. - Meets defined coding productivity standards. - Applies broad guidelines to specific coding situations, utilizing discretion and analytic ability. - Understands the use of diagnosis and procedure codes, and reimbursement methodologies for reimbursement, public reporting, quality of care, financial modeling, strategic planning, and marketing. - Remains current with coding and industry changes through educational opportunities. - Demonstrates thorough knowledge of professional coding guidelines, medical terminology, anatomy/physiology, and payer specific coding guidelines. - Notifies coding leadership of trends and topics for education and feedback to physicians and departments. - Assists with identification and implementation of process improvements according to industry best practice standards. - Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association/American Association of Procedural Coders. Qualifications - High School Diploma/GED - Required - Associate or Bachelor's Degree - Preferred - 1 Year Coding - Required - CCS, CCS-P, or CPC - Required - RHIT/RHIA - Preferred Requirements - Travel is required: Never or Rarely - Job Range: Coder III Spcl Profess Specialty Srvc Procedural $19.46-$28.96 - Incentive: Not Applicable Benefits Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

Role Description Responsible for implementation of initiatives to improve documentation and coding accuracy for Lumeris clients. Regularly reviews provider medical records for accurate and complete documentation and coding. Supports retrospective chart reviews as well as pre-visit planning and post visit coding. Primary Responsibilities: - Reviews medical records in support of pre-visit planning and post-visit program for opportunities with complete and accurate documentation and coding. - Identifies chronic conditions for providers to review during patient visits. - Queries providers to ensure complete and accurate documentation and coding after patient visits. - Partners with providers and clinical/administrative staff to enhance understanding of Clinical Documentation Improvement program goals in order to achieve Risk Adjustment strategic goals and initiatives. - Maintains current subject matter expertise by attending professional meetings, seminars, and related continuing education events. - Collaborates with internal teams to assure client/project-specific goals are met. - Reviews project-specific documentation and code specificity for validation. - Supports in oversight (overreads) of coding vendor. - Responsible for communication, input, and findings to support Senior Auditors. Qualifications - Bachelor's degree or equivalent. - 3+ years of ICD-10 outpatient coding and provider query experience or the knowledge, skills, and abilities to succeed in the role. - Strong knowledge of ICD-10-CM Coding Guidelines, E/M, CPT/HCPCS, CMS-HCC risk adjustment model, medical record review project management, encounter data management, and IPM/RADV Medical Record Reviewer Guidance. - Coding certification as CPC. - Demonstrated ability to work cross-functionally within corporate matrix environments. - Effective ability to collaborate and partner on complicated initiatives. - Firm verbal and written communication skills. - Favorable computer skills (i.e. Microsoft Office). Requirements - Associate degree or technical school (preferred). - CPC-I or CRC Certifications (preferred). Benefits - Medical, Vision and Dental Plans. - Tax-Advantage Savings Accounts (FSA & HSA). - Life Insurance and Disability Insurance. - Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days). - Employee Assistance Program. - 401k with company match. - Employee Resource Groups. - Employee Discount Program. - Learning and Development Opportunities. - And much more...

Role Description The Medicare D Biller serves as a primary liaison for the Clinical Hub, maintaining proactive communication with pharmacists, healthcare facilities, physicians, and Prescription Drug Plans (PDPs) regarding therapeutic interchange opportunities and prior authorization requests. This role is responsible for: - Researching payment denials by contacting insurance plans to determine the cause of denials. - Coordinating with facilities to obtain supporting information. - Updating and documenting prior authorizations, including clinical justifications. - Ensuring the accurate and timely completion of all required authorization forms. The position requires a high level of attention to detail when initiating, processing, and tracking prior authorizations on behalf of customers. Responsibilities include: - Working closely with EMAR systems, healthcare facilities, and clinical teams. - Serving as a key point of contact throughout the prior authorization process. - Ensuring efficient coordination, thorough documentation, and successful resolution of authorization requests. Remote work is available, with the requirement to work Central Time Zone hours. The schedule is Monday - Friday, 11am - 7:30pm Central Time Zone. Qualifications - High School Diploma; Associates degree preferred; Bachelor's degree preferred. - Certified Pharmacy Technician or Medical Assistant Certification desired. - Third party Medical Billing experience. - EMAR system knowledge. - One to three years of pharmacy experience preferred. - Three years of call center experience preferred. - Understanding of insurance and Medicaid formularies and processes including the prior authorization processes. - Familiar with the claim adjudication process. - Proficiency in Microsoft Office programs. - Ability to prioritize work to meet daily and competing deadlines. Requirements - Act as a resource to the facilities in obtaining information, completing necessary documentation, or following up on outstanding claims. - Make outgoing calls to facilities, plans, and physician’s offices as needed to obtain approvals. - Work with Client Billing Service Offices, Pharmacy Directors, customers, and prescription drug plans to effectively communicate and resolve customer issues. - Perform other tasks as assigned. - Achieve productivity goals with regard to calls/claims per hour as determined by the Director and Clinical Hub Manager. - Provide clinical support to members of the RxAllow team regarding prior authorization concerns/submissions. - Conduct job responsibilities in accordance with the standards set out in the Company’s code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. - Develop a strong understanding of the insurance verification, adjudication, back-end billing process, and become a subject matter expert on the insurance queues and billing workflow. Benefits - Medical, Dental, Vision insurance. - Health Savings & Flexible Spending Accounts (up to $5,000 for childcare). - Tuition discounts & reimbursement. - 401(k). - Company Paid Time Off. - Shift Differential. - DailyPay. - Pet Insurance. - Employee wellness and discount programs.